Workplace Injuries and Pre-Existing Conditions

In some instances, a workplace injury may not create a new condition but aggravate an old one. Pain from an old back injury for instance can re-appear if you bend over to pick something up in just the right (…or wrong) position.

In short, any injury that occurs at your job is considered a workplace injury.

Therefore, if an old injury or pre-existing condition is aggravated by an incident at work, it should be covered under workers’ compensation. Back injuries are the most common types of conditions that apply in these cases but it can involve anything.

And while some may claim otherwise, it doesn’t matter if the original cause of your pre-existing condition was a work injury or not. What matters is if the condition became aggravated, re-appeared or became worse due to an incident at work.

Unfortunately though, many insurance companies, employers and even treating physicians appointed by your insurer will try and claim your pre-existing condition is not their responsibility to cover. They may claim that the cause of your prior back pain re-appearing is due to the condition itself, or the result of activities outside of work.

Often times, injured workers are convinced that their conditions are not covered since they were pre-existing, despite claims that activities at work caused them to return.

However, a work injury that aggravates a pre-existing condition really only has to meet some minimum criteria and are evidenced by the following:

  • A new need for treatment of your pre-existing condition

  • An increased need for treatment of your pre-existing condition (i.e. Chiropractor care was sufficient before but now I require surgery!!)

  • An accelerated need for treatment of your pre-existing condition (i.e. Knee replacement surgery may have been needed in 10 years but with the job injury, it’s needed immediately)

As you can see from these criteria, the key factor in determining if a pre-existing condition is covered by Colorado workers’ comp is the change in medical treatment following an injury.

There is a good chance though that your employer or their workers’ comp insurance company will claim your pre-existing condition is not covered, which is why you should be prepared with good documentation and even witnesses if possible. Report your work injury as soon as practically possible after it occurs and take detailed notes of all incidents, treatments, etc.

Work injuries that aggravate a pre-existing condition are a bit harder to prove so we can’t stress the point of documentation and witnesses enough.

Part of this documentation for your case will most certainly involve a medical exam. Your employer’s insurer is responsible for assigning a physician for you to go see.

Following all the medical exams and diagnoses, the doctor will issue a disability rating and notify the insurance carrier. The insurer will take this information and decide whether they will admit or deny your claim. If you do NOT agree with this final assessment, you do have the right to request a “Division Independent Medical Examination (DIME)”.

(Read “What if My Workers’ Compensation Doctor is not Providing the Proper Care?”   for more information on independent medical exams).

It is also possible for your employer/insurer to request a DIME for your case as well.

If your case does indeed go this far, a judge will ultimately decide if your work injury aggravated your pre-existing by carefully weighing the evidence and each physician’s opinion.

In the end, never take your employer’s or their insurer’s word that your pre-existing condition is not covered under workers’ compensation. Consulting with a Colorado workers’ compensation attorney is the best way to ensure you receive all benefits afforded to you under the law.

Don’t just accept no for an answer – do your own research and keep your own records. This often times makes the difference between success and failure.

Continue reading these related articles for more information…

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Discuss the details of your claim with a Colorado Workers' Compensation lawyer at The Babcock Firm today. No matter where you are in the state of Colorado, if your case falls within our practice area and we feel our representation can benefit you, an attorney will conduct an in-depth consultation at no charge. We are here to help you secure a successful outcome. Contact us today and learn more about how representation works.

Disclaimer

While the Babcock Law Firm tirelessly works to obtain successful outcomes for its clients, prior positive outcomes are no guarantee of future success. Indicating prior positive results is in no way intended to guarantee future results.

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